单中心腹膜透析相关性腹膜炎的临床分析  

Clinical analysis of peritoneal dialysis-associated peritonitis in single center

作　　者：张宇 史健 ZHANG Yu;SHI Jian(Shaanxi Provincial Hospital of Chinese Medicine,Xi'an 710000,China)

机构地区：[1]陕西省中医医院,陕西西安710000

出　　处：《临床医学研究与实践》2021年第35期17-19,26,共4页Clinical Research and Practice

基　　金：陕西省卫生计生科研基金项目(No.2016B001)。

摘　　要：目的分析腹膜透析相关性腹膜炎的临床特点、致病菌特点及耐药状况。方法回顾性分析2011年3月至2020年5月我院132例腹膜透析患者的临床资料,按照是否发生感染性腹膜炎将患者分为观察组(69例)与对照组(63例)。分析两组患者的实验室指标水平。根据腹水培养及药敏试验结果分析病原菌的分布情况及耐药情况。结果观察组的血肌酐、Ca、Mg、尿素、尿酸、Na、P、血浆白蛋白、前白蛋白、胆固醇水平均低于对照组(P<0.05)。69例腹膜炎患者中,细菌培养阳性患者58例,未培养细菌11例。共分离病原菌62株,其中革兰阳性菌(G^(+))株37例,占比为59.68%;革兰阴性菌(G^(-))株25例,占比为40.32%;无真菌感染。G^(+)菌对青霉素的耐药率最高,占比为90.00%,未发现对利奈唑胺、万古霉素、喹努普汀/达福普汀耐药的G^(+)菌。G^(-)菌对氨苄西林、阿莫西林克拉维酸钾有较高耐药率,占比分别高达100.00%、83.33%,未发现对美罗培南、哌拉西林/他唑巴坦耐药的G^(-)菌。结论腹膜透析相关性腹膜炎患者的营养状况较非腹膜炎患者差,应结合腹膜炎病原菌分布特点及患者具体情况,合理使用抗菌药物。Objective To analyze the clinical characteristics,pathogenic bacteria characteristics and drug resistance of peritoneal dialysis-associated peritonitis.Methods The clinical data of 132 peritoneal dialysis patients in our hospital from March 2011 to May 2020 were retrospectively analyzed.The patients were divided into observation group(69 cases)and control group(63 cases)according to whether infectious peritonitis occurred.The laboratory index levels of the two groups were analyzed.The distribution and drug resistance of pathogenic bacteria were analyzed according to the results of ascites culture and drug sensitivity test.Results The levels of serum creatinine,Ca,Mg,urea,uric acid,Na,P,plasma albumin,prealbumin and cholesterol in the observation group were lower than those in the control group(P<0.05).Among 69 patients with peritonitis,58 cases were positive for bacterial culture and 11 cases were uncultured.A total of 62 strains of pathogenic bacteria were isolated,including 37 cases of Gram-positive bacteria(G^(+))strains,accounting for 59.68%,25 cases of Gram-negative bacteria(G^(-)),accounting for 40.32%,and no fungal infection.The drug resistance rate of G^(+)bacteria to penicillin was the highest,accounting for 90.00%.No G^(+)bacteria resistant to linezolid,vancomycin and quinuptine/dafuptine were found.G^(-)bacteria had high resistance rates to ampicillin,amoxicillin and clavulanate potassium,accounting for 100.00%and 83.33%respectively.No G^(-)bacteria resistant to meropenem and piperacillin/tazobactam were found.Conclusion The nutritional status of peritoneal dialysis-associated peritonitis patients is worse than that of non-peritonitis patients.Antibiotics should be used reasonably in combination with the distribution characteristics of peritonitis pathogens and the specific situation of patients.

关 键 词：腹膜透析相关性腹膜炎 临床特点 致病菌 

分 类 号：R572.2[医药卫生—消化系统] R692.5[医药卫生—内科学]